Two approaches to cancer of the cardia

摘要

The optimum approach to cancer of the cardia is a controversial issue. Tumours at this location can be resected either via an abdominal incision, or via a left thoracoabdominal approach, which many physicians prefer. lntheory,thethoracoabdominal approach enables a more thorough lower mediastinal lymphadenectomy and a safer oesophageal surgical margin. The abdominal approach, however, does not require a thoracotomy with its potential morbidities and increased pulmonary complications, and a mediastinal anastomosis can be done safely with a stapler without the need of a separate thoracic exposure.The lesser extent of mediastinal nodal dissection might not be important, because the outlook for patients with such metastases is poor.